Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

More documents

Recommendations

Info

for all FGDs as well as for all users and traditional providers, and signed informed consent forms for13 entry interviews with xefe and all other providers.Section 4 – Results4.1 Participants4.1.1 SurveyTLSLSThe TLSLS cross-sectional sample included 4,500 households, comprising 25,000 individuals. Thesample was approximately half male (50.8%) and half female (49.2%). The ages of the householdmembers ranged from 0–98 years, with an average age of 23 years. Half (50.6%) were aged 18 orover; among this group 61.9% were married, 27.9% never married, 9.2% widowed and less than 1%divorced or separated.The most commonly reported mother tongue was Mambae (22.5%), followed by Tetum (17.7%) andBaequeno (14.2%). All other mother tongues were reported at rates less than 10%. Most peoplespoke Tetum (86.4%) even if it was not their mother tongue, and over a third (39.7%) spoke BahasaIndonesian. A further 15.8% reported speaking Portuguese and only 4.6% spoke English. Consistentwith the largely subsistence population of Timor-Leste, the main occupations cited were schoolstudent (25.4%), farmer (19.2%) farm labourer (17.4%) and housewife (16.5%), most of whom alsoworked in the fields.HCSBSTimor-Leste Health Care Seeking Behaviour Study | 2009The final HCSBS sample included 535 households, comprising 3,126 individuals. Similar to the TLSLSsample, the HCSBS sample was approximately half men (50.5%) and half female (49.5%). Agesranged from 0–94 years, with 52.1% aged 18 or over. Most of those over 18 years (60.3%) weremarried, with 29.0% never married, 9.2% widowed and less than 1% divorced or separated.In this sample the most widely spoken mother tongue was Mambae (28.1%) with Tokodete (8.4%),Tetum (7.8%) and Tetum Terik (7.6%) the next most common. A large proportion reported to be ableto speak Tetum (83.4%), over a third spoke Bahasa Indonesian (37.8%), and slightly more than in theTLSLS spoke Portuguese (21.8%) and English (7.1%). Occupations were broadly similar to the TLSLSsample: school student (34.6%), housewife (12.5%) and farm labourer or farmer (15.9%, 7.1%),although there was a greater proportion of students in HCSBS.Across all 13 districts, health care seeking data was collected from 535 household heads (equivalentto a 92% response rate based on a target of 585) and 771 individuals—404 women (69% responserate) and 367 men (63% response rate). Most of the missing households had declined to participate;a few had moved.4.1.2 QualitativeThirteen interviews were conducted with village heads.23
Thirty-two interviews were conducted with providers: 6 midwives, 5 nurses, 2 nurse assistants, 4doctors, 2 PSFs, 1 pharmacy assistant, 1 clinic manager, 1 leprosy consultant, 1 kiosk medicine sellerand 1 traditional medicine producer, as well as 5 TBAs (usually mentioned as daia, also dukun,badaen liman, liman loos), 1 healer-shaman (matan dook) and 2 bone setters (ruin tohar). 8 Oneprovider (kiosk medicine seller) withdrew permission to use his information at the conclusion of theinterview.Twenty-nine interviews were conducted with service users: 22 women, 6 men, and the parents of asick child (interviewed together). The female users included 5 women accompanying sick children tothe health facility and 1 woman attending for family planning.A total of 38 FGDs were held across 10 districts, with a maximum of 8 and minimum of 4 participantsin each group. FGDs for married women (10 FGDs with a total of 78 participants) and married men(10 FGDs, 75 participants) were better attended than those for adolescent females (9 groups, 56participants) and adolescent males (9 groups, 52 participants). Overall, the level of participation anddiscussion was higher in the men’s groups than the women’s groups.4.2 General health care seeking4.2.1 Problems experienced and providers usedTLSLSIn the TLSLS 23.3% of the total25,000 individuals reported thatthey had experienced a healthproblem in the previous 30 days. Themost prevalent complaint was acough (31.6%), which was more thantwice as common as the next mostprevalent complaint, a fever or“dengue fever”. Malaria (selfdefined)was also commonlyreported; other complaints includedheadaches, stomach ache,joint/muscle pain and cold (Table 1).Amongst those that had experienceda health problem in that time, 17.3%were unaffected in terms of capacityto work, however 50.6% missed 1–5days of work.Table 1- Health problems in the past 30 days (TLSLS sample)Primary health complaintNo. of people affectedn (%)Cough 1,838 (31.6)Malaria 674 (11.6)Fever/dengue fever 828 (14.2)Headaches 511 (8.8)Stomach ache 423 (7.3)Joint/muscle pain 293 (5.0)Cold 292 (5.0)Other 252 (4.3)Back pain 190 (3.3)Diarrhoea 111 (1.9)Skin problem 108 (1.9)Stomach disorder 88 (1.5)Asthma 63 (1.1)Accidents 54 (0.9)Toothaches 49 (0.8)Ear pain 44 (0.8)Total 5,818 (100)8 This report translates ‘matan dook’ (literally eye + far) as healer-shaman (following the lead of the World Bank’squalitative study into health service delivery and utilisation prepared by Alexander Edmonds). The healer-shaman wasincluded as one of several traditional providers who are influential in relation to health care seeking. Where custom (adat)is suspected to be the cause of illness, a matan dook may be consulted to assist a household to determine the nature of thecause and facilitate the resolution of unsettled custom matters, thereby clearing the way for a traditional or biomedicaltreatment to relieve the person’s symptoms. In this sense, the HCSBS refers to the Timorese practice of consulting a healershamanas constituting a health care seeking action.24Timor-Leste Health Care Seeking Behaviour Study | 2009
Page 3 and 4: AcknowledgementsWe acknowledge the
Page 5: ForewordHonourable Minister of Heal
Page 12 and 13: Recommendations for the Ministry of
Page 14 and 15: Section 1 - Introduction1.1 Backgro
Page 16 and 17: 1.3.2 Timor-Leste Survey of Living
Page 18 and 19: Satisfaction with services was diff
Page 20 and 21: households. Within each household,
Page 22 and 23: Once the final set of questions was
Page 26 and 27: Treatment for the illness was sough
Page 28 and 29: mothers carrying infants the journe
Page 30 and 31: (tau todan) should something go wro
Page 32 and 33: Box 2: Midwife demonstrates care of
Page 34 and 35: 4.2.7 MedicationIn relation to trea
Page 36 and 37: esponsibility may be partly mitigat
Page 38 and 39: with bloody diarrhoea (tee raan) to
Page 40: push, preventing premature pushing
Page 43 and 44: In the previous 12 months, 43.3% of
Page 45 and 46: Most informants referred to the nor
Page 47 and 48: The HCSBS survey investigated proce
Page 49 and 50: antenatal care: weighing pregnant w
Page 51 and 52: drug compliance. 27 Some providers
Page 53 and 54: survey activity with little discern
Page 55 and 56: Figure 7 - Improving access, qualit
Page 57 and 58: Education of women is a particularl
Page 59 and 60: 5.4.4 Recommendations for developme
Page 61 and 62: 27. Beiersmann C, Sanou A, Wladarsc
Page 63 and 64: Appendix 2 - Birth spacing narrativ
Page 65 and 66: Appendix 4 - User-provider interact
Page 67 and 68: Appendix 5 - User blame of provider
Page 70: TIMOR-LESTE HEALTH CARE SEEKING BEH

Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?